Perceived Difficulty Accessing Healthcare in Guinea: A Population-Based Analysis of Financial, Organizational and Geographic Barriers
Abstract:
Background: In Guinea, access to healthcare remains constrained despite facility availability. Objective: to estimate the prevalence and determinants of perceived difficulty obtaining care. Methods: We analyzed 2024 Afrobarometer Round 10 survey data from Guinea (n=1,200; n=948 with facility contact) using survey-weighted statistics and multivariable logistic regression. Results: 59.2% of respondents reported difficulty obtaining care. The most frequent barriers were high costs and informal payment requests (36.1% each), followed by long waiting times (22%) and drug shortages (16.2%). After adjustment, perceived difficulty was associated with informal payment demands (OR=2.11; 95% CI:1.54–2.87), high costs (OR=1.89; 1.35–2.63), long waiting times (OR=1.56; 1.03–2.35), and urban residence (OR=1.49; 1.10–2.03). Conclusion: Financial and organizational barriers are the main drivers of perceived access difficulty in Guinea; addressing fees, informal payments, and waiting times is essential to improve access.References:
[1]. World Health Organization. Primary health care on the road to universal
health coverage: 2019 monitoring report. Geneva: World Health Organization;
2019.
[2]. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et
al. Mortality due to low-quality health systems in the universal health
coverage era: a systematic analysis of amenable deaths in 137 countries.
Lancet. 2018;392:2203–12. https://doi.org/10.1016/S0140-6736(18)31668-4
[3]. World Bank. World development indicators: Guinea. Washington (DC): World
Bank; 2023.
[4]. Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchal B, et al. Equity
in antenatal care quality: an analysis of 91 national household surveys. Lancet
Glob Health. 2018;6:e1186–95. https://doi.org/10.1016/S2214-109X(18)30389-9
[5]. Andersen R, Newman JF. Societal and individual determinants of medical
care utilization in the United States. Milbank Mem Fund Q Health Soc.
1973;51:95–124. https://doi.org/10.2307/3349613
[6]. Bago JL, Adégnika AA. Healthcare utilisation and associated factors in
sub-Saharan Africa. BMC Health Serv Res. 2021;21:567. https://doi.org/10.1186/s12913-021-06578-8
[7]. Saksena P, Antunes AF, Xu K, Musango L, Carrin G. Mutual health
insurance in Africa: evidence from Ghana, Rwanda, and Tanzania. Health Econ.
2014;23:713–27. https://doi.org/10.1002/hec.2945
[8]. Afrobarometer. Afrobarometer Round 10 survey, Guinea. Accra:
Afrobarometer; 2024.
[9]. Bratton M, Mattes R, Gyimah-Boadi E. Public opinion, democracy, and
market reform in Africa. Cambridge: Cambridge University Press; 2005.
[10]. Lumley T. Complex surveys: a guide to analysis using R. Hoboken (NJ):
John Wiley & Sons; 2010.
[11]. R Core Team. R: a language and environment for statistical computing.
Vienna: R Foundation for Statistical Computing; 2023. Available from: https://www.R-project.org/
[12]. Pebesma E. Simple features for R: standardized support for spatial
vector data. R J. 2018;10:439–46. https://doi.org/10.32614/RJ-2018-009
[13]. Moran PAP. Notes on continuous stochastic phenomena. Biometrika. 1950;37:17–23. https://doi.org/10.1093/biomet/37.1-2.17
[14]. Anselin L. Local indicators of spatial association—LISA. Geogr Anal.
1995;27:93–115. https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
[15]. Bivand RS, Wong DWS. Comparing implementations of global and local
indicators of spatial association. TEST. 2018;27:716–48. https://doi.org/10.1007/s11749-018-0599-x
[16]. Lewis M. Governance and corruption in public health care systems.
Washington (DC): Center for Global Development; 2006. Working Paper.
[17]. World Health Organization. World health statistics 2024: monitoring
health for the SDGs, Sustainable Development Goals. Geneva: World Health
Organization; 2024.
[18]. World Health Organization. Primary health care measurement framework and
indicators: monitoring health systems through a primary health care lens.
Geneva: World Health Organization; 2022.
[19]. United Nations. The Sustainable Development Goals report 2024. New York:
United Nations; 2024.
[20]. GBD 2021 Universal Health Coverage Collaborators. Measuring universal
health coverage based on an index of effective service coverage in 204
countries and territories, 1990–2021: a systematic analysis for the Global
Burden of Disease Study 2021. Lancet. 2024;403:2305–40.
[21]. World Bank. World development indicators 2024. Washington (DC): World
Bank; 2024.
[22]. Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived
difficulties in healthcare access in sub-Saharan Africa. PLoS One.
2019;14(9):e0223223. Doi:10.1371/journal.pone.0223223.
[23]. Kabia E, Molyneux S, Barasa E, Muraya K, et al. The hidden financial burden of healthcare: a systematic literature
review of informal payments in sub-Saharan Africa. Wellcome Open Res.
2022;7:160. Doi:10.12688/wellcomeopenres.17228.1.
[24]. Rajan S, Santoso C, Aji MA, et al. Gender differences
in informal payments for healthcare: evidence from 34 African countries. Health
Policy Plan. 2022;37(1):14–24. Doi:10.1093/heapol/czab123.
[25]. Lagarde M, Palmer N. The impact of user fees on health service
utilization in low- and middle-income countries: how strong is the evidence?
Bull World Health Organ. 2008;86(11):839–48. Doi:10.2471/BLT.07.049197.
[26]. Leive A, Xu K. Coping with out-of-pocket health payments: empirical
evidence from 15 African countries. Bull World Health Organ.
2008;86(11):849–56. Doi:10.2471/BLT.07.049403.
[27]. Artignan J, Bellanger M. Does community-based health insurance improve
access to care in sub-Saharan Africa? A rapid review. Health Policy Plan.
2021;36(4):572–84. Doi:10.1093/heapol/czaa174.
[28]. Ahinkorah BO, Ameyaw EK, Seidu AA, Odusina EK, Keetile M, Yaya S.
Examining barriers to healthcare access and utilization of antenatal care
services: evidence from demographic health surveys in sub-Saharan Africa. BMC
Health Serv Res. 2021;21:125. Doi:10.1186/s12913-021-06129-5.
[29]. Adugna MB, Nabbouh F, Shehata S, Ghahari S. Barriers and facilitators to
healthcare access for children with disabilities in low and middle income
sub-Saharan African countries: a scoping review. BMC Health Serv Res.
2020;20:15. Doi:10.1186/s12913-019-4822-6.
[30]. Barasa E, Kazungu J, Nguhiu P, Ravishankar N. Examining the level and
inequality in health insurance coverage in 36 sub-Saharan African countries.
BMJ Glob Health. 2021;6(4):e004712. Doi:10.1136/bmjgh-2020-004712.
[31]. Frimpong AO, Amporfu E, Arthur E. Effects of public and external health spending on out-of-pocket payments for healthcare in sub-Saharan Africa. Health Policy Plan. 2022;37(9):1129–37. Doi:10.1093/heapol/czac068.
